Patient Flow Roundtable: Tips for Managing the Retina Practice

In today’s climate of ever-changing regulation and narrowing payment networks, young ophthalmologists will be asked to do more with less. So you need your clinic flow to be as efficient as possible.

While your practice might be running smoothly today, tomorrow’s bottlenecks might leave you hours behind schedule. What are the best ways to tackle these challenges?

In a new roundtable series, YO Info takes a look at how individual practices and different subspecialties manage patient flow. This month’s focus is on the private retina clinic. Find out below how two YOs and one administrator manage their patient numbers and how you can integrate their ideas into your own practice.

Practice Flow in a Multispecialty Group Practice

EyeHealth Northwest in Portland, Ore. is a multispecialty group with 26 ophthalmologists (three dedicated to retina) and nine optometrists. We talked to retina specialist Brian Chan-Kai, MD, six years in the practice, and administrator/CEO Ann M. Hulett, COE, CAE, who’s been with the practice three years.

What is your practice’s patient volume?

Dr. Chan-Kai: My daily average hovers around 60 patients a day, although there is some variability depending on location, with the busiest pushing beyond 70 patients a day.

How does your practice handle high patient volume in a time-efficient manner?

Dr. Chan-Kai: The current prevalence of intravitreal therapy in retina practices dictates that we need to see patients on a frequently recurring basis. Unfortunately, the treatment intervals are often fairly rigid, meaning that rescheduling is not an effective way to manage the schedule. As such, we’re obliged to continue treating these patients indefinitely in a timely fashion, so overbooking unfortunately becomes common in a mature practice.

If one considers a clinic day split into a morning and an afternoon session, my preference is to schedule postoperative visits and injections earlier in each day so that I can move through those patients efficiently before starting to see the more time-intensive new patient visits. I also tend to put scheduled laser sessions (especially panretinal photocoagulation) at the end of the day, as the time needed to complete that can vary based on patient tolerance.

Do you have any creative solutions for managing patient numbers and making the finances work?

Ms. Hulett: The leadership of the physician in the pod is key though. As a young ophthalmologist, you have a great impact on how your team functions. You hustle, they hustle. You teach, they learn. If you are glad to see a full schedule and confident that you can handle the schedule, your staff will be too. On the other hand, showing your stress and frustrations will spread and have a negative impact on the practice flow and the patient experience.

Team efficiency ultimately increases when the physician arrives on time, stays in the lanes and consistently and clearly communicates with the staff about what did and did not go well during the day.

How do you get things back on track when practice flow slows down?

Dr. Chan-Kai: To prevent slowdowns from happening, it’s useful to have a lead technician or myself look through the upcoming clinics to verify what type of patients are scheduled and what the anticipated photography and surgery needs will be.

But when the flow does bog down, one basic key is communication with any patients who are waiting. The doctor will be buried in work and trying to catch up with the backlog, so empathetic patient interaction from the front-desk staff and technicians goes a long way.

How does your practice handle ancillary studies such as OCT, photography and angiography?

Ms. Hulett: Hiring individual staff to perform these tasks is expensive. The best scenario is when the staff can perform multiple roles, moving back and forth throughout the day as the lanes fill.

However, this does depend on the type of diagnostic testing. Optical coherence tomography, visual fields and external photography, for example, are skills that every technician should be able to perform. For IOL calculations or angiography, on the other hand, the practice benefits from having the same staff working with surgeons in order to reduce the likelihood of error.

Another important factor is whether you schedule tests in advance or do them on an as-needed basis. We schedule our visual fields ahead of time because of how long it takes for the patient to complete the test. This means we need a designated person available for that specific session or the entire day.

Assigning an individual to a full day of OCTs, however, can be detrimental to their job satisfaction. At the same time, it’s not efficient to have the entire staff doing OCTs and standing around waiting for the instrument. So for our retina team, we assign a half day’s worth of OCT duty to an individual and rotate the staff as needed.

How do scribes and surgery schedulers fit into your practice?

Dr. Chan-Kai: In my clinic, the surgery scheduler is indispensable, so our ability to work closely together is critical. My scheduler is assigned exclusively to me and cross-trained to help prep intravitreal injections or set up equipment (e.g., ultrasound or laser) if necessary. This cross-training is especially useful because the clinic time helps him develop better relationships with our patients. It’s also very helpful to be able to ask him questions regarding insurance authorization on the fly. And on days when I’m not in clinic, he then has the time to manage the surgery schedule and tend to other administrative duties.

The role of the scribe is evolving in my practice. Currently, I use a technician to help me scribe. This might not be the most valuable use of the technician, but I’ll frequently have them start patient visits as usual. If technicians get ahead of me in workups, I’ll have one of them join me to scribe and help minimize my computer/EHR time.

Practice Flow in a Retina-Only Group

For perspective from a smaller, more specialized practice, we talked to retina specialist D. Wilkin Parke III, MD. A YO in his third year of practice, he discussed practice flow at VitreoRetinal Surgery, PA, a Minneapolis-based retina-only group practice with 12 ophthalmologists.

What is your practice’s patient volume?

Dr. Parke III: Our patient volume as a whole is probably on the busier side for a practice of our size. We generally have around eight doctors in clinic at any given time and see about 2,000 to 2,400 patients per week. Our clinics tend to have a high number of new patients each day, in addition to the established ones.

How does your practice handle high patient volume in a time-efficient manner?

Dr. Parke III: We value and reward well-trained, motivated and bright employees. Our staff training protocols are lengthy and designed to develop employees who are cross-trained for multiple roles, facile with the electronic medical records and very knowledgeable about retina disease and treatments. As a result, they are extraordinarily adept at interpreting imaging and understanding procedures. We have also tried hard to develop and constantly monitor a lengthy series of metrics regarding patient flow and productivity.

How do you get things back on track when practice flow slows down?

Dr. Parke III: Both the doctor and the clinic supervisor look days (and even weeks) ahead at the clinic schedule, the inventory, the staffing calendar and the OR availability and make sure that any and all scheduling problems are avoided early. And in the clinic each day, the supervisor will monitor for bottlenecks and move around staff and resources to facilitate flow accordingly. We also have additional flex rooms that can be used for working up patients and clinical trial participants or just for extra physician space.

How does your practice handle ancillary studies such as OCT, photography and angiography?

Dr. Parke III: The OCT and angiography equipment is in dedicated imaging rooms adjacent to the rooms for working up patients. We also have a director of photography who is superb and has an ongoing training schedule for our other technicians, most of whom are capable of doing high-quality OCT or angiograms.

She has a system of structured feedback regarding photo quality and photographer performance. Photographers have their results reviewed regularly and receive helpful didactic instruction.

With this system, I’m always assured that all imaging can be performed efficiently and at the highest level — no matter which of our clinics I’m working in.

How do scribes and surgery schedulers fit into your practice?

Dr. Parke III: We have a separate surgery scheduler in each clinic who can also scribe if needed. They also know their counterparts well at each of our ORs and can quickly coordinate additions or changes to the surgery schedule. Most of our technicians are also trained to scribe, and we make sure to rotate them around to so that they maintain their skills.

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About the author: Mike Mott is a former assistant editor for EyeNet Magazine and contributing writer for YO Info.